Lecture 4 - Contraception Flashcards

1
Q

Sponge info

A

1 time use

insert 24hrs before, leave in for at least 6, no more than 30 hrs

OTC

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2
Q

Diaphragm info

A

plastic, reusable and lasts 2 yrs

have to fit it with provider and use w/ spermicide

its RX

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3
Q

Cervical Cap info

A

used up to 2 yrs

used combo w/ spermicide

its RX

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4
Q

Conditions when estrogen is not preferred?

A

Migraine headaches
> 35yrs old and smoker/obese
History of thromboembolic disease
Cardiac disease, CAD or HF
Cerebrovascular Disease
Hypertriglyceridemia
HTN + vascular disease or > 35yr old

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5
Q

What does Phasic Mean

A

Mono = same estrogen/progestin each pill
Bi = same estrogen, progestin inc about half way
Tri = hormones change every 7 days

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6
Q

Conventional vs extended cycle

A

21 active + 7 inactive

or can do active nonstop or 84days active/ 7 inactive

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7
Q

Estrogen Dosing & SE

A

30mcg = normal

higher doses = more SE, forgiving dosing, less bleeding
Lower = less SE, less forgiving dosing, more bleedings

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8
Q

Progesterone Dosing & SE

A

Earlier gen = more androgenic (less clotting and more SE)

Later Gen = more estrogenic (less term SE, more Estrogenic SE)

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9
Q

Counseling points for Birth control

A

same time every day
at night w/ food if N/V occurs
Managing missed pills
When to start

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10
Q

Starting methods

A

Quick = start use back up for 7 days
Sunday = start 1st Sunday after menses and backup for 7 days
1st day start = start on day 1 menses, no backup needed

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11
Q

Managing Early breakthrough bleedings

A

days 1-9

switch to higher estrogen or switch to multiphase pill with higher estrogen in beginning of cycle

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12
Q

Managing late breakthrough bleeding

A

days 10-21

Switch to higher progestin or switch to multi phasic pill w/ high progestin dose at end of cycle

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13
Q

DI w/ Birthcontrol

A

Anticonvulsants
NNRTIs
Protease inhib
ABX = rifampin

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14
Q

How to counsel if late/miss pill

A

< 24hrs = take as soon as possible and continue rest usual time

if miss > 2 pills, start on back up contraception

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15
Q

Progestin only pills

A

“mini pills”

used for pts on inc clot risk
migraines
lactating women

Has to be taken same time each day

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16
Q

Progestin only pills, what to do if miss

A

< 3 hrs, take asap
> 3 hours, use backup for 2 days

Drosperinone = improved missed dose time

17
Q

IUD Menses SE Cooper vs LNG

A

Copper = longer and heaver menses, more crampign

LNG = spotting in 1st 6 months, amenorrhea

copper preferred in pts who dont want hormones used

18
Q

IUD SE

A

Common = ab pain, Fatigue, HA, Dizziness, breast tender, nausea

Rare = Expulsion of IUD, perforation cervix/uterus, infections

19
Q

Implant Birthcontrol

A

Nexplanon
Good for 3yrs (5 yrs off-label)

SE = irregular bleeding, mood change and weight gain

put in by provider

20
Q

Injectable Birthcontrol

A

DepoProvera
done every 3 months
Given IM or SubQ

SE = irregular bleeding, weight gain, osteoporosis risk = take with Vit D/calcium

back up 1st 7 days after 1st, or if more than > 15 weeks since injection (so miss 3 month mark)

21
Q

Transdermal Patch Birthcontrol

A

Xulane, Twirla

1 patch QW for 3 weeks, then 1 patch free week

Decreased efficacy if BMI > 30

Safety = inc exposure to estrogen

22
Q

Vaginal Ring Birthcontrol

A

Nuvaring = brand = every 3 weeks
EluRyng = generic
Annovera = can be reused for 1 year

Less N/V than other options

Safety = Amy inc vag secretions and irritation

23
Q

When is progestin only products or Copper IUD recommended

A

> 35yrs old +

BMI > 30
DM
Uncontrolled HTN
Smoker
Migraines
Immobile

24
Q

if pt experience Aura with Migraines then they are….

A

at inc risk go stroke = Progestin ONLY

if no aura = estrogen OK

25
Emergency Contraception eligibility criteria
child-bearing age who experienced these events in last 120hrs.... unprotected sex contraceptive failure sexual assault repeated use of EC doesn't make someone ineligible
26
LNG emergency contraceptives how it works
used to prevent fertilization and implantation effectiveness wanes over time** most effective up to 72hrs
27
LNG emergency contraceptives info
OTC efficacy dec those who weight > 165lbs or BMI > 25 given as one dose ASAP
28
Ella MOA & info
inhibit/delay ovulation ** Effectiveness doesn't decrease over time**** Selective progesterone receptor modulator take within 5 days, and can use BMI > 25, but efficacy decreases > 35
29
Emergency Contraceptives IUD
Paragard = copper IUD has to be inserted 5 days after sex and 99% effective
30
Counseling for EC
if vomit within 2-3 hrs, repeat dose Won't protect against HIV/STI If menses > 1 week late...take a preg test Take the drugs ASAP, pref within 72hrs
31
Obese pts special info
Progestin only if BMI > 25 Ella (Ulipristal Acetate) can be used BMI 25 -35 Copper IUD if > 35 BMI